Transcript Medical Home Chapter Champion Orientation Webinar

Medical Home Chapter
Champion Orientation Webinar
November 10, 2010
7 – 8 pm CST
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Chuck Norlin, MD, FAAP
MHCCPA Project Advisory Committee Chairperson
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Webinar Overview
• Welcome, Overview & Project History
• Medical Home and Asthma: Making it Work in
Practice
• Project Highlights
• Chapter Champion Roles & Responsibilities
• Q&A
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How It All Began…
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AAP Comprehensive Asthma Program (CAP)
• Phase I: Chapter Alliance for Quality Improvement
(CAQI) / Chapter Quality Network (CQN) Asthma Pilot
Project
▫ Support structure offered by AAP chapters as a provider of
QI programs
▫ 4 Chapters: AL, ME, OH, OR (49 practices, 282 clinicians)
▫ Asthma EQIPP module serves as project’s means for
concurrent data collection
• Phase II: Medical Home Chapter Champions
Program on Asthma (MHCCPA)
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Funding & Timeline
• Merck Childhood Asthma Network, Inc. (MCAN)
▫ Foundation, funded by the philanthropic arm of
Merck
▫ Non-profit 501 c(3) organization established to
address the growing problem of pediatric asthma
• 2-year program which started in November
2009
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Rationale for Phase II (MHCCPA)
• Receiving care within the context of medical home has
potential to improve care for children and youth with
asthma, especially for children living in poverty, who
have dramatically higher rates of adverse outcomes such
as emergency department visits, hospitalizations and
death
• MHCCPA is also based on success of Academy’s Early
Hearing, Detection & Intervention (EHDI) Chapter
Champions Program
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Program Overview
• Overarching Goal: To facilitate dissemination of
best practices and advocacy related to asthma
care within a medical home
• Program Goals:
▫ Increase access to a medical home for all children and
youth, with a specific focus on health disparities
▫ Facilitate pediatric practices’ adoption and
implementation of NHLBI asthma guidelines within
context of a medical home
▫ Increase advocacy efforts for implementation of
asthma care within medical homes at chapter/state
level(s)
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Jennifer Lail, MD, FAAP
John Meurer, MD, MBA, FAAP
MHCCPA Project Advisory Committee Members
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Imagine:
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Staff recognizing a parent when appointment is made
Adequate time scheduled for that child
Prior asthma care plan on chart
Specialist’s records in your hands prior to the visit with
lab, allergy testing, spirometry, X-ray results
Parent concerns identified before the visit; multiple tasks
completed at the visit
Lab slips ready and EMLA cream on child prior to visit
Help by your staff for families with referrals, resources,
equipment, forms
Follow-up to assure completion of tasks
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What is a Medical Home?
“The Medical Home is the model for 21st
century primary care, with the goal of addressing
and integrating high quality health promotion,
acute care and chronic condition management in
a planned, coordinated and family-centered
manner.”
-American Academy of Pediatrics
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Joint Principles of Medical Home
AAP, AAFP, ACP, AOA, 2007
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Personal physician
Physician-directed practice
Whole-person orientation
Coordinated care
Quality and safety
Enhanced access
Appropriate payment
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Essential Components of a
Medical Home System
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Ready Access
Relationships/Respect
Registry and Records
Resources
Reimbursement
Recruitment
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NIH Asthma Guidelines
NHLBI NAEPP, 2007
Expert Panel Report 3: Guidelines for the
Diagnosis and Management of Asthma
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Principle 6: Enhanced Access
• Pediatrician availability to assess, classify and
monitor asthma severity and control
• Reduce disparities in processes and outcomes in
asthma care
▫ Socioeconomic
▫ Racial/ethnic
▫ Geographical
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Ready Access
• Accept Medicaid, many insurers
• Evening, Weekend and Holiday office hours for
asthma flares
• 24-hour advice nurses (? To the ED or not?)
• Translation Phone
• Privacy protection for Teens (cigarettes, THC)
• ADA accessible physical plant
• Handicapped parking spaces
• Policy on Transition to Adult Care (age, process)
• Identified Adult Providers
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Principle 1: Personal Physician
• Provide continuity of care in a partnership
• Schedule routine follow-up care
• Monitor use of beta2-agonist medications
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Relationships/Respect
• Patient and Family—enhanced appt/med compliance
• MH Staff—help for asthma teaching, spirometry, flu
shots
• Specialists—support for difficult cases, education
• Schools—asthma care for when parents not present
• Insurers—payment, surveillance for med overuse,
noncompliance
• Community Providers—Medicaid Care managers, social
workers, summer camps, smoking cessation
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Principle 2: Physician-Directed Medical
Practice
Coordinate services for children with asthma that
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Family-centered
High-quality
Accessible
Affordable
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Principle 3: Holistic Orientation
• Control of environmental triggers
▫ Allergens
▫ Irritants, especially tobacco smoke
• Treat and prevent co-morbid conditions
• Promote physical fitness and
nutrition for children with asthma
• Help address socioeconomic barriers
to well-being
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Principle 4: Coordinated Care
• Integrate care across the community
• Use information technology
▫ Asthma registry
▫ Electronic health record
 Performance and outcomes measures
 Accountability
• Add electronic health record
• Refer to specialist, if needed
• Transition teens to adult care
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Registry/Records:
Knowing Who Needs Care
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Registry can be paper or electronic
Notebooks  Excel  Access EMR
Alerts schedulers to need for more time for visit
Assures key data to specialist for consult
Track referrals and specialist reports
Prompt Pre-visit contacts
Data management for flu shots, ACP on chart
Data recall for self-assessment of care quality
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Electronic Records Make Asthma Care Easier
• Chart is never “lost”
• Permits “tracking” of asthma visits, both acute
and planned
• Medication doses/strengths/refill dates are
recorded
• Specialty consults are easily accessed
• Asthma plan, allergies are on chart
• Asthma education printouts available
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Principle 5: Quality and Safety
• Patient-centered, evidence-based care
• Establish the asthma diagnosis
• Provide asthma education on patient selfmanagement
• Prescribe and adjust medications
▫ Inhaled corticosteroids are preferred for persistent
symptoms
▫ Stepwise treatment based on age
• Develop a written asthma management plan
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Resources/Care Coordination Services
• Care Coordination services for referrals, visit planning,
equipment, collaboration with other providers
• Centralized data base (paper or electronic) of local
resources
• Family Support Networks for Parent-to-Parent support
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Community asthma educational supports
Smoking cessation programs for patient, family
School nurse links for acute care
Referral assistance; information exchange with other
providers
▫ Specialty providers for allergy, pulmonology evaluations
▫ Local suppliers for environmental controls, spacers,
nebulizers, oximeters
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Care Coordinators Aid
Collaboration/Comanagement with Specialists
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Care coordinators as bridges to service
Assure that referral data sent and visit accomplished
Access to Specialist records (letter, fax-back, electronic)
Phone/email dialogue re: care
Specialty follow-up at PCP office (hospital/ED follow-up,
labs, etc)
• Synthesis of thought from multiple specialists
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AAP Quality and Safety Resources
• Chapter Alliance for Quality Improvement
www.aap.org/member/chapters/caqi/
• Medical Home Chapter Champions Program on
Asthma
www.medicalhomeinfo.org/national/mhccpa.aspx
• Education in Quality Improvement for Pediatric
Practice (EQIPP)
www.eqipp.org
 CME
 MOC Part 4
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Principle 7: Appropriate Payment
• Added value provided to patients with asthma
who receive care in a medical home
• Adequate fees
• Bundled payments
• Accountable care organizations
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Reimbursement for Asthma
Management
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Schedule and charge for chronic care management visits
If available and trained, charge for spirometry
Proper coding for care of CSHCN
Charge for after hours visits
Contract renegotiations with insurers (data!)
Charge for MDI teaching, asthma education, oximetry,
nebulizations
• Demonstrate low ED/hospitalization rates to insurers for
contract renegotiations
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Recruitment—Yes, YOU
• One family in five has a CSHCN who needs
pediatric care; asthma is one of most common
chronic condition in Peds
• Parents, insurers, government are demanding
Quality Improvement in care systems
• Planned, supported care is more fun to deliver!
• Where do you want to start?
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Suzi Montasir, MPH
MHCCPA Program Manager
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MHCCPA Project Advisory Committee
Members
• Chuck Norlin, MD, FAAP,
Chairperson
• Allen Harlor, Jr, MD, FAAP
• Jennifer Lail, MD, FAAP
• Julie Katkin, MD, FAAP
• Mitchell Lester, MD, FAAAI, FAAP
• John Meurer, MD, MBA, FAAP
Liaisons
• Beth Dworetzky, MS
• Rhonda Hertwig, CPNP
• Linda Lee, APR
• Marie Mann, MD, FAAP
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Chapter Champion Regional
“Networks”
Districts I & II:
Dr Lester
(CT, MA, ME, NH, NY1, NY2,
NY3, RI, USE, VT)
Districts VII & X
Dr Katkin
(AL, AR, FL, GA, LA, MS, OK,
PR, TX)
Districts III & IV
Dr Lail
(DE, DC, KY, MD, NC, NJ, PA,
SC, TN, VA, WV)
Districts V & VI
Dr Meurer
(IA, IL, IN, KS, MI, MN, MO,
ND, NE, OH, SD, WI)
District VIII
Dr Harlor
(AK, AZ, CO, HI, ID, MT, NM,
NV, OR, USW, UT, WA, WY)
District IX
Dr Norlin
(CA 1, CA 2, CA3, CA 4)
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Education in Quality Improvement for
Pediatric Practice (EQIPP)
• Web-based activity that helps to evaluate and improve
the quality of care provided to patients in practice
• ABP-approved Performance in Practice Quality
Improvement Activity (Part 4 MOC) and CME credit
www.eqipp.org
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EQIPP Scholarships for Champions
• All chapter champions are eligible to receive a
scholarship for either of the following EQIPP courses:
▫ Diagnosing and Managing Asthma in Practice
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▫ Medical Home for Pediatric Primary Care
(NOW AVAILABLE!)
• Send an e-mail to Corrie Pierce ([email protected]) to
request one of the above scholarships
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MHCCPA Webinar Series
• “Hot Topic” Series (3 total)
▫ Tentative Schedule: 2011—Jan, Apr, Nov
▫ Available to all AAP members
▫ Focus on larger medical home/asthma topics
• Chapter Champion Series (3 total)
▫ Tentative Schedule: 2011—Mar, Jun, Sept
▫ Focused webinars, as follow-up to “hot topic” webinars
• Continuing Medical Education (CME) anticipated
for both
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Chapter Champions Conference
• Save the Date!
▫ February 25 – 26, 2011
• Location
▫ Chicago, IL
• Format
▫ 1.5 Days
▫ Plenary & break-out sessions
▫ Chapter champion networking opportunities and
more!
• Continuing Medical Education (CME) anticipated
• ALL travel expenses will be paid by the program
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MHCCPA Web Page
http://medicalhomeinfo.org/national/mhccpa.aspx
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Visiting Professorship Program
• Opportunity for chapter champions and/or chapters to request a
speaker who will highlight aspects of medical home implementation
and a speaker who will be able to present on optimal asthma care
• 10 VP programs offered throughout 2011
• Priority may be given to areas where there is high incidence of
health disparities and demonstrated need for education on NHLBI
guidelines implementation and medical home
• MHCCPA VP program will cover both travel expenses and faculty
honoraria
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Chapter Champion Roles & Responsibilities
• Chapter Champion Orientation Guide
▫ On its way to your office/home!
• Getting Started
▫ “Roles, Responsibilities & Implementation Ideas”
▫ Chapter Champion “Top Ten” List
▫ Chapter Champion Year 1 Work Plan (template)
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Thank You!
Questions?
Contact:
Suzi Montasir, MPH
Program Manager,
AAP Division of Children with Special Needs
800/433-9016, ext 4311
[email protected]